Drug Interactions between azilsartan medoxomil and Lithium Carbonate ER

MONITOR CLOSELY: Concomitant use of angiotensin II receptor antagonists may increase the serum concentrations of lithium. The exact mechanism of interaction is unknown, but thought to be related to the natriuresis induced by angiotensin II receptor antagonists secondary to the inhibition of aldosterone secretion. Increased steady-state lithium concentrations and lithium toxicity have been reported in association with the interaction, sometimes with a delayed onset of up to several weeks after coadministration.

MANAGEMENT: Given the narrow therapeutic index of lithium, caution is advised during coadministration with angiotensin II receptor antagonists, particularly in the elderly or patients with other risk factors (e.g., sodium restriction, renal impairment, congestive heart failure, dehydration, concomitant use of diuretics or NSAIDs). Pharmacologic response and serum lithium levels should be monitored more closely whenever an angiotensin II receptor antagonist is added to or withdrawn from therapy, and the lithium dosage adjusted as necessary. Empiric reductions of both drugs may be appropriate during initial therapy. Renal function should also be monitored regularly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, muscle weakness, vomiting, diarrhea, polydipsia, polyuria, tinnitus, tremor, ataxia, and blurred vision.

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